The Use of Simulation to Improve Resident Communication and Personal Experience at End-of-Life Care

Abstract

Pediatric residents report they are not sufficiently trained to communicate with families at a child's death. We performed a study to prove feasibility and assess whether simulation improves their communication and experience. Residents were assigned to intervention using simulation or control group. Communication was assessed by standardized patients and audiotapes of simulated encounters when they delivered bad news. Residents' perceptions of their communication were polled. The majority reported they never witnessed end-of-life discussions. All residents perceived themselves to be more capable at pronouncing the death of a child, and informing a family of a death after participating in either the interventional simulation or a bereavement retreat. Despite training within a pediatric intensive care unit, pediatric residents have little exposure to end-of-life discussions. Pediatric end-of-life simulation increases exposure of residents to end-of-life care and improves residents' perceptions of their communication.

Keywords

simulation - end-of-life care - communication

• References

• 1 McCabe ME, Hunt EA, Serwint JR. Pediatric residents' clinical and educational experiences with end-of-life care. Pediatrics 2008; 121 (4) e731-e737
• 2 Yang CP, Leung J, Hunt EA , et al. Pediatric residents do not feel prepared for the most unsettling situations they face in the pediatric intensive care unit. J Palliat Med 2011; 14 (1) 25-30
• 3 Ptacek JT, McIntosh EG. Physician challenges in communicating bad news. J Behav Med 2009; 32 (4) 380-387
• 4 Rider EA, Volkan K, Hafler JP. Pediatric residents' perceptions of communication competencies: implications for teaching. Med Teach 2008; 30 (7) e208-e217
• 5 Malacrida R, Bettelini CM, Degrate A , et al. Reasons for dissatisfaction: a survey of relatives of intensive care patients who died. Crit Care Med 1998; 26 (7) 1187-1193
• 6 American Academy of Pediatrics. Committee on Bioethics and Committee on Hospital Care. Palliative care for children. Pediatrics 2000; 106 (2, Pt 1): 351-357
• 7 Committee on Palliative and End-of-Life Care for Children and Their Families. Field MJ, Behrman RE , eds. Educating health care professionals. In: When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Washington, DC: Institute of Medicine; 2003: 328-349
• 8 Rosenbaum ME, Ferguson KJ, Lobas JG. Teaching medical students and residents skills for delivering bad news: a review of strategies. Acad Med 2004; 79 (2) 107-117
• 9 Gillan PC, Jeong S, van der Riet PJ. End of life care simulation: a review of the literature. Nurse Educ Today 2014; 34 (5) 766-774
• 10 Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Crit Care Med 2011; 12 (1) 33-38
• 11 Sawyer T, Laubach VA, Hudak J, Yamamura K, Pocrnich A. Improvements in teamwork during neonatal resuscitation after interprofessional TeamSTEPPS training. Neonatal Netw 2013; 32 (1) 26-33
• 12 Venkatasalu MR, Kelleher M, Shao CH. Reported clinical outcomes of high-fidelity simulation versus classroom-based end-of-life care education. Int J Palliat Nurs 2015; 21 (4) 179-186
• 13 Smith-Stoner M. Using high-fidelity simulation to educate nursing students about end-of-life care. Nurs Educ Perspect 2009; 30 (2) 115-120
• 14 Galushko M, Romotzky V, Voltz R. Challenges in end-of-life communication. Curr Opin Support Palliat Care 2012; 6 (3) 355-364
• 15 Neumann M, Bensing J, Mercer S, Ernstmann N, Ommen O, Pfaff H. Analyzing the “nature” and “specific effectiveness” of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Educ Couns 2009; 74 (3) 339-346
• 16 Milstein JM, Raingruber B. Choreographing the end of life in a neonate. Am J Hosp Palliat Care 2007; 24 (5) 343-349
• 17 Moody K, Siegel L, Scharbach K, Cunningham L, Cantor RM. Pediatric palliative care. Prim Care 2011; 38 (2) 327-361 , ix
• 18 Munson D. Withdrawal of mechanical ventilation in pediatric and neonatal intensive care units. Pediatr Clin North Am 2007; 54 (5) 773-785 , xii
• 19 Serwint JR. The use of standardized patients in pediatric residency training in palliative care: anatomy of a standardized patient case scenario. J Palliat Med 2002; 5 (1) 146-153
• 20 Serwint JR, Rutherford LE, Hutton N, Rowe PC, Barker S, Adamo G. “I learned that no death is routine”: description of a death and bereavement seminar for pediatrics residents. Acad Med 2002; 77 (4) 278-284
• 21 Bylund CL, Makoul G. Examining empathy in medical encounters: an observational study using the empathic communication coding system. Health Commun 2005; 18 (2) 123-140
• 22 Redinbaugh EM, Sullivan AM, Block SD , et al. Doctors' emotional reactions to recent death of a patient: cross sectional study of hospital doctors. BMJ 2003; 327 (7408): 185 . Doi: 10.1136/bmj.327.7408.185
• 23 Schiffman JD, Chamberlain LJ, Palmer L, Contro N, Sourkes B, Sectish TC. Introduction of a pediatric palliative care curriculum for pediatric residents. J Palliat Med 2008; 11 (2) 164-170
• 24 Leighton K. Death of a simulator. Clin Simul Nurs 2009; 5 (2) 59-62
• 25 Phrampus PE, Cole JS, Winter PM. Perceptions of experiencing simulated death. Poster presesnted at: 6th Annual International Meeting on Medical Simulation; January 14-17, 2006; San Diego, CA
• 26 Bokken L, Linssen T, Scherpbier A, van der Vleuten C, Rethans JJ. Feedback by simulated patients in undergraduate medical education: a systematic review of the literature. Med Educ 2009; 43 (3) 202-210
• 27 Montagnini M, Smith H, Balistrieri T. Assessment of self-perceived end-of-life care competencies of intensive care unit providers. J Palliat Med 2012; 15 (1) 29-36